Massive baby - what would you do?

[AnxiousMamo]

I’ve just been diagnosed with gestational diabetes after baby was measuring 6lb at 34 weeks. All of the measurements were 85th centile plus, with the stomach measurement being off the scale (!)

My first baby was 8lb 15oz, and this one looks set to be even bigger. First DC I had to be induced which was awful and I ended up with an episiotomy, ventouse and I was unable to urinate afterwards for a week (I needed a catheter). It was pretty traumatic, although I was able to look after DC and be mobile straight after birth which was good.

I have another scan next week when I will be 37 weeks, and they will compare measurements and the consultant will advise me. They have given me two options - induction at 39 weeks or an elective caesarean. Both carry risks. With induction there is the risk it won’t work, I may need intervention again, tears, episiotomy and shoulder dystocia for the baby. With a caesarean there are the usual associated risks. The consultant did they that as I have had a big baby previously, that is a good sign for a vaginal birth.

I am wondering if any others have been in this situation and how it went for you, what did you decide? How was the birth?

Thanks in advance.

I had gestational diabetes and my son went from 50th percentile to 99th percentile very quickly.
I wasn’t able to control my blood glucose with diet or metformin (despite my best efforts) so ended up using insulin.
I had gestational diabetes related complications including polyhydramnios and went into labour early.
I’d already had a c-section scheduled so that was brought forward and he was delivered at 35+6 weeks. He weighed nearly 7 pounds so would have been huge by 40 weeks!

I decided I wanted a c-section because I knew I was going to need continuous monitoring, glucose/insulin during labour and an induction if I went past 39 weeks. I also knew there was an increased risk of complications etc, so it seemed like the safest option. The obstetrician and midwife were happy to let me weigh up the risks and let me decide what I thought was best for me.
The c-section was totally fine, recovery was really quick and nowhere near as painful as I thought (I was able to shower and go down to the hospital coffee shop the next morning- albeit slowly!)

I was going to say it will be fine but given how your first birth went I'd opt for an ELCS and then you can plan childcare & recovery

I’d go for a section. I know a few people induced and they all ended up in an emergency section. For a big baby and previous difficult delivery I’d opt for an elective section and save yourself the hell of an induction which will probably end up with the same outcome anyway

Op obviously an elc is a big op.
You are in an operatives theatre with big drugs etc. But it's so straight forward and less room for error because it happens in a calm and controlled professional atmosphere.

There are less unknowns.

I would choose it any day over a possibly traumatic vaginal birth and baby having it's shoulder dislocation.

After is when you suffer more but again it's less suffering because it's on the stomach and nothing to do with the under carriage, it's about the incision snd again nothing else eg perenium, no physical straining...

You can't win when it comes to birth and pain but I much preferd my wondeful calm and controlled elc to the vag birth.

My little darling was 11.2lbs. Always measured big on scans (no diabetes though). I had a scheduled c-section at 40+5 and it was the best thing for us.
It took a huge amount of stress away and she was delivered safely and it took less time. My husband was with me the whole time. I was able to have delayed cord clamping and skin to skin straight after like I requested.
Recovery was painful but nowhere near what you're describing in the recovery from your first birth.
Wishing you all the best!

I dislike the way medics present elc as a last resort sometimes as if it's so awful.

I had gestational diabetes with 2nd baby. I was diet controlled and baby was not considered macrosomic so it was a little different, baby was measuring big ish, bigger than 1st but within range (i think abdo circumference was closest to out of range on 91st percentile). This meant for me they were willing to let me get to 40+6, but wanted to start induction at 40+3 to ensure baby was out by 40+6.
Rightly or wrongly the idea of induction terrified me. It sounded to me like risks such as shoulder dystocia happened more often during such interventions. So instead I agreed with them that I could get to 40+6 and then I would have a section.

In the end I went into labour naturally at 40+3 (the night of 40+2 but it was after midnight). Labour 2nd time around was much faster, they seemed to be right that body remembers. 1st baby gave me a 2nd degree tear, this one a minor 1st degree.

I wonder in hindsight if I was right to fear induction, but it is worth knowing labour is likely to be easier 2nd time round. My situation is a little different as baby wasn't as big and I was allowed to go a little later, but just wanted to share my experience. I have heard that elective sections are usually a much more positive experience than a natural birth with interventions, so that was part of my reasoning (although I was worried about recovery with a not very careful 4 yr old likely to jump all over me)

I also was allowed a water birth after completing a risk assessment and agreeing it with the consultant midwife but again my situation was perhaps a bit lower risk so its up to you if you think it is worth pushing for. They need to be able to monitor baby safely.

How do you avoid getting GD? I have my test in 2 weeks time, and my baby is in 95th percentile for abdominal circumference.

sorry to hear you’ve been given this very difficult choice. Good luck with it.

I would go for elective section, after previous experiences.

My 2nd DD was 10 days overdue, after my bump measuring consistently big but scans showing big but not massive. Labour was spontaneous, progressed fairly quick (3am wake up to pushing 9am) but unfortunately she just couldn't move down the birth canal. I was moved to surgery for a ventouse at 2.30pm as she was showing signs of distress, but when we got in there she wasn't even far down enough for that, so she was born by emergency c section at 3.15pm.

I'd been telling them for weeks it felt like she was too big, as I'd gone in for various sweeps/ reduced movements, and each time I was dilated with small contractions, but each time she moved back out of the engaged position and everything stopped- I firmly believe there wasn't enough room for her.

She was 9 lb 13.5, 2nd baby but 15 year gap between.

Just to add that I didn’t have any risk factors for gestational diabetes and so I’d been hoping to have a water birth with minimal interventions (although obviously agreeing to any interventions as necessary if things changed during labour).
As it became increasingly clear that wasn’t going to happen and that my birth was going to be higher risk than I hoped it shifted the balance for me about what felt like the safest and least stressful course of action.

I know you mentioned that you’re worried about recovery. Whilst some people do have difficulty recovering from a c-section it’s definitely not universal (and planned c-sections generally have a much easier recovery than emergency ones).

The first couple of days are hard and being mobile is definitely painful/uncomfortable initially, but I only needed one dose of the strong opiate pain relief and by day 3 I was able to get about fairly easily.
By day 5 we went out for dinner and I was able to walk around pretty comfortably.
By the end of week 3 I was completely back to normal apart from slight ‘tugging’ in my scar if I overdid it.
By week 6 I wouldn’t even have known I’d had a c-section.

It’s not necessarily the experience for everyone but of all my friends who’ve had c-sections most have had a similar experience. People who have vaginal deliveries can also experience complications/interventions that mean their recovery is more difficult or slower than they’d hoped.

Obviously lots of people have good experiences with vaginal births (and in a low risk pregnancy they’re the safest option), but I just wanted to reassure you that a c-section won’t necessarily be a terrible experience and difficult recovery. I’m TTCing at the moment and will happily have another c-section!

I didn't have GD but my DS was a big baby at 9lb 7oz. I had the same - was induced 3 days early due to pre eclampsia and he got stuck (shoulder dystocia) and needed ventouse. It was a bit of an ordeal!

Anyway when I was pregnant with DD I spoke to the consultant and decided for an elective C-section. It was a much more relaxed birth and I don't regret it for a second! She was big too (8lb 12 at 39 weeks) so definitely made the right decision there.

My recovery time was actually easier with the c-section as I still had to have a load of stitches with the vaginal birth

There are some risk factors that you can control:

• Diet- Low in sugar and refined carbohydrates. Choosing complex carbohydrates and pairing them with protein or fat to slow the absorption (e.g. rather than just having toast you have it with egg and avocado and choose a wholemeal bread).
• Exercise- Trying to do 10-20 minutes exercise after each meal (even just a walk is fine).

Longer term things like your weight will affect your risk of gestational diabetes (and type 2 diabetes).

However there are lots of risk factors that you can’t control (genetics, ethnicity, age).

I also had no risk factors and a borderline result on the GD test and ended up having very bad gestational diabetes and some of the complications that go along with it. Even with a very strict diet and exercise regime I still needed medication and eventually insulin. So sometimes it’s just bad luck.

It went away within hours of my son being delivered though. Although I am higher risk for getting it again in future pregnancies and for getting Tupe 2 diabetes so I’ve been working on my lifestyle and losing a bit of weight before getting pregnant again (my BMI was the higher end of healthy going into my last pregnancy and it’s now the lower end of healthy).

My 1st was 8lb 4 and ended up an emergency c section due to getting stuck. On my 2nd was automatically placed under consultant care. Lots of scans and confirmed he was a large baby. I was offered a c section which I agreed to and he was 10lb 2 (very glad I did). Just wanted to say if you go got this option please don't worry, it was very straightforward, calm and whilst it does take a few weeks to heal it was still worth it

I'm pushing for a section in your position right now, lassie is over the 100th centile. The problem is I've given birth naturally to an 11lb02oz baby previously and a 11lb pretty much on the dot.
Because I didn't require surgery, the consultant is being a fucking nightmare over just accepting my decision for a section.
I also want to be sterilised and she's said no, even though 4 kiddos is quite enough for my family. I've chosen a large family but I think at mid 30s I should now be able to say I'm more than comfortable with my choice to not have anymore.
It's even been asked, "what if she wants a sister" well she'll want a sister won't she, I wanted a unicorn but it's not held me back in life.

I can say even though my deliveries have been relatively straightforward, it's really knackered my bladder and I am aware that pregnancy will have played a role in its downfall (see what I did there 😁) but I can say pushing out 11lb babas doesn't do the prolapse any good nor, being brutally honest, your self esteem.

Technically I know my vagina is OK, I mean it's not winning any awards these days but still, people do constantly want to ask me about it and I'm honest with them, it's not quite the "wizard sleeve" I've been asked is it, but even being asked,
(Once by a tesco cashier) about it doesn't make you feel your best.

Re tesco worker, she was lovely, very kind about my giant baby and very chatty etc, she was in awe as she'd had very little babas, but she genuinely was worried about my vagina and did ask me all about it whilst I was just surrounded by awkward older blokes all nodding trying to not listen in 😁

i had 3 induced babies. The first was 9 and a half pounds and yes it wasn’t easy - but the second were rapid and easy births and they were both 8 pounds and over. So in my own experience the second and subsequent labours were a totally totally different ball game to the first.

I was able to give birth to large babies with ease though - and they were all 2 weeks late. Don’t know if that helps

Also, this was my biggest baby, if anyone knows me in person hello 👋

But just to show you, they are not messing around with how large they are.

But so so squishy

This is good, but just to flag also that they might ask you to follow a particular diet the day before the test - not at my Trust, but some do.

I had a full fish and chippy serving the night before and passed no problems - have to do it again because he has a fat belly, but I'm not expecting a GD diagnosis.

I have been staying very active though (borderline HG, so eating has been a bit of a moot point).

Mine weren't huge, huge, but they were 2lb bigger than my birth weight. Both times I had spontaneous labours but had back to back babies and a knackered pelvis with SPD.
Labour 1 was long, draining and ended with EMCS after 2 hours of pushing, 36 hours in HDU and DS having obs for a few hours in NICU. It was 3 weeks before I felt strong enough to carry DS on the stairs.
Labour 2 was shorter and going well then DS's heart rate went awry, so off to theatre ASAP. It ended up being a rough forceps rather than a rough EMCS as he'd just about reached the point of no return. It was 4 weeks before it ceased to be agony to sit on a chair and I felt safe enough to drive.

When I was caught up in the baby bubble, I had this desire to birth my babies naturally and give my body chance to do what it was allegedly designed to do. However after 2 different emergency surgical forms of birth after labour, if I was to have another baby, I'd go for the more predictable odds on ELCS.

The ELCS birth stories from people I know tend to be very positive. Where they have been more complex, there were significant health issues involved anyway.
The inductions that have tended to be smoother tended to be at the end of term where mums had already been through labour and didn't require much intervention to initiate. They often result in long, exhausting labours and it's a gamble that I'd rather avoid.

Hello OP,

I had gestational diabetes in two of my pregnancies and had elective sections for both. My first was over 8lbs at 37 weeks. I would definitely recommend it for a lot of reasons, one being that a long and protracted induction will be hard and tiring for both you and baby and could negatively impact your blood sugar situation. Even with the c section my first had low blood sugars and had to have lots of heel pricks to measure their blood sugar level.

Have the elective c section. Recovery from a straight forward elective C is easier and more straight forward than a vaginal birth with complications. Multiple obstetrician gynecologists have told me this (I had a big baby and shocking vaginal birth resulting in permanent birth injuries).

I'd go for elective CS. My first was
10lbs 5 & I'd had to have emergency cs as he got stuck. Had elective 2nd time at 37 weeks & was 9lb 3. They can put on a 1lb a week in the last few weeks & for me the risk of shoulders getting stuck was too much

It has been so helpful to read everyone’s stories, thank you so much for replying.

I am extremely worried about perineal injury, especially due to what happened last time, which I guess would be considered ‘mild’! I don’t think my body is made to push these big babies out, as I struggled last time after an exhaustive induction (and I was only 20 at the time)!

Interestingly, I’ve had much more pain this pregnancy and I did wonder if that could also be due to the weight of the baby. I struggle to walk around without being in pain and have lots of low muscle and back pain which I didn’t with my last.

I wish I could have the lovely, natural birth I envisioned but whatever I decide, I will end up hooked up to machines and monitors, like my last birth. I know I am able to refuse induction and interventions but this doesn’t seem very wise given the circumstances.

I will update the thread after the 37 week scan and then again after the birth, for anyone who might be reading this on the future!

I know you've had dozens of stories already - mine is very similar to many that have been shared here by other mums.

My first baby was 10lbs 7 and a horrendous labour experience. I was in labour for days, they added induction drip to try to speed things up but realised he was stuck in my pelvis and was an emergency c section. I was exhausted, it was awful.

For my second I was offered the option of a section or a vbac. I had a point to prove to myself about giving birth so I opted for the vbac. I really regret it! The second was 10lb 4 and ended up needing a lot of help to get out. Keillands high rotational forceps, shoulder dystocia, episiotomy, huge blood loss, the works. The recovery was brutal and the labour experience was traumatic.

In your shoes I'd book in a calm, planned section and know that if your baby is going to be very large you are going to be able to deliver them safely and probably have a straightforward recovery.

I wish you all the best: good luck.

@Threeladsandaweelassie Ahh your baby is gorgeous, very squishy 😃My last baby was very long and just solid, so strong from birth and able to support their head! They went straight into 0-3 clothing!